Nowadays, when a person requires a surgical procedure in the course of which the cutting of a bone structure or removal of tissue adjacent to said bone structure is necessary, the surgeon usually carries out a broad approach both to provide a good view of the operating field as well as to protect the adjacent structures. To achieve this, he must carry out considerably large incisions in the skin, muscles, and other tissue of the patient, placing separators and protection material such as gauze and dressings, to protect noble structures such as nerves, which could otherwise be damaged in the course of the cutting procedures. In addition to the risk of damaging organs or surrounding tissue in the area where the incisions are carried out, there is also the risk of cutting a blood vessel which could render the surgical procedure more difficult and dangerous.
In the prior art there are several devices to carry out cuts in bone structures and/or the removal of tissue, which use protecting elements to avoid damage to contiguous structures or organs. Such is the case of the device described in U.S. Pat. No. 8,062,300 B2, which is formed by an elongated main body which comprises a proximal handle, a distal handle, a guiding conduit and a guiding wire; these latter two elements connecting the proximal and distal handles. The proximal handle is connected to a guiding conduit, which is formed by a rigid proximal section and a flexible distal section, at the end of which a coupling element is located, which enables connection between said guiding conduit and a guiding wire. On one of the surfaces of the flexible distal section, tissue modifying elements are located, which carry out the material removal function of said device.
To keep the tissue modifying elements from damaging structures or tissues before they have reached the working area, they are covered by a protective cover, made preferably from polymer material. The guiding wire is coupled on its other end to the distal handle, which includes a tensioning element which is used to modify the tension level of the guiding wire.
However, the above device described above has a drawback in that its design is not ergonomic, which makes its use by the medical team more difficult. Another disadvantage is that the cut carried out by the device is performed by material removal instead of a clean cut, as well as the further drawback that being a very flexible device, only very small structures may be cut. In addition to the above, said device does not include a mechanism which enables regulation and measurement of the cut in the spatial planes.
Another example of devices found in the prior art is the one described in U.S. Pat. No. 8,048,080 B2, which comprises a main body formed by an elongated body, a handle, an actuator, tissue modifying elements and a protecting surface. The elongated body has a proximal and a distal section, which includes a window to enable the tissue modifying elements to make contact with the tissue to be modified. Before introducing the elongated body in the area with tissues to be modified, a guide piece must be inserted, which will act as guide and support element for said main body; as the elongated body is introduced in the body of the patient, the guide piece is inserted in the central part of said elongated body, once the elongated body is placed in its working position, the free end of the guide piece which projects outwards from the body of the patient is held firmly; the handle is held firmly as well, and by operating the actuator, the tissue modifying elements begin to carry out their abrasion or cutting function. Once the procedure is completed, the main body and the guide piece are removed from the body of the patient.
The above described device, because of its configuration and design, requires at least two people to perform adequately, since it is required that the opposite end of the guide piece is firmly held, either by means of an anchoring device or by the hand of an operator. As in the case of the device of U.S. Pat. No. 8,062,300 B2, said device cuts by abrasion and not by means of a clean cut, and does not include a mechanism which allows regulation and measurement of the cut on any spatial plane.
A further example of devices in the prior art can be found in U.S. Pat. No. 6,423,080 B1 which describes a device employed to hold or secure structures and/or organs, which comprises a pair of positioning pieces, which are formed by a handle, a guiding conduit, a bracket, a cutting element and an actuator. The handle has a hollow tubular body which has an actuator in its upper section and a bracket in its lower section which holds the guiding conduit in position. Said handle has an irregular outer surface to improve the grip.
The guiding conduit has a straight proximal section, a curved intermediate section and a straight distal section. In an additional embodiment of said device, the straight distal section is oriented at a 90° angle with respect to the position of the straight proximal section. In addition, the guiding conduit is hollow to house the cutting element which in turn is hollow to allow passage of the guiding piece. The cutting element is employed to create a small aperture in the tissue and allow passage of the positioning element.
One of the main disadvantages of said device is that it is conceived solely to locate a cord or sling on a tissue or structure that so requires, not for cutting bone structures. In addition to the above, to position the cord or sling requires removal of both positioning elements and of the guiding piece, which makes operating the device considerably difficult.